The Open Heart Surgery Risk Stratification Project Data Collection Form, Version 4.1. Instructions and Data Specifications

Transcription

1 The Open Heart Surgery Risk Stratification Project Data Collection Form, Version 4. Instructions and Data Specifications EFFECTIVE JANUARY, 202

2 Table of Contents Page Introduction General Information... 2 Data Submission Quarterly Activity Annual Activity Audit and Department Review... 4 The Cardiac Surgery Report... 4 The Open Heart Surgery Risk Stratification Project Data Collection Form... 6 Data Definitions and Specifications... 9 A. Demographics... 9 B. Hospitalization... C. Preoperative Risk Factors... 5 D. Previous CV Interventions... 9 E. Preoperative Cardiac Status F. Preoperative Medications G. Preoperative Hemodynamics and Cath H. Operative Procedure I. Coronary Bypass Surgery J. Valve Surgery... 3 K. Other Procedures L. In Hospital Complications Operative Infection Neurologic Pulmonary Renal Vascular Other M. Mortality... 4 Appendix I: Application for Case Exclusion Appendix II: Payor Classification Appendix III: File Layout

3 INTRODUCTION This document contains information about the Open Heart Surgery Risk Stratification Project (Project), the revised data collection form (Version 4.), definitions of data elements, and the file layout for the Project. The data definitions follow definitions issued in Version 2.73 of the National Cardiac Surgery Database by the Society of Thoracic Surgeons (STS). In addition to maintaining consistency with STS revisions, the current revision is intended to simplify data capture and reporting including data management and analysis. As an example, we have provided three separate fields for a surgeon s name (first name, last name and middle initial) on the data collection form. In addition, we have included a license number field for each surgeon to improve identification and volume reporting. Another key revision on the new form is that all data elements are assigned numeric codes. This practice is expected to minimize data entry time as well as the time it takes to manage the data. Among other minor revisions made on the form are adding a Not Discharged option against Discharge Status, revised payor codes to maintain consistency with other administrative data and a new field on status of a patient 30 days after surgery. The Department of Health and Senior Services, Office of Health Care Quality Assessment is available to assist you with any questions you may have on the Open Heart Surgery Risk Stratification Project. If you have any questions or comments please contact the Office of Health Care Quality Assessment at (609) You may also contact us by regular mail at the following address: Open Heart Surgery Project Office of Health Care Quality Assessment New Jersey Department of Health & Senior Services 240 West State Street, th floor P.O. Box 360 Trenton, New Jersey 08625

4 GENERAL INFORMATION Data Submission All hospitals that are licensed to perform adult open heart surgery are required to provide data on each patient. Data are to be submitted every quarter to the Department within thirty (30) days after the close of the quarter. The data submission schedules are as follows: Quarter Months Included in Data Submission Due Date First January March April 30 Second April - June July 30 Third July - September October 30 Fourth October - December January 30 The data collection form provided in this document is a guide for data entry and is not intended to be completed or submitted with the data file. Data may be collected using any vendor provided program, but must be submitted following the format specified in Appendix III of this manual. Data may be submitted on a 3.5" diskette/cd or electronically through a secure file transfer protocol. If you need to compress the data file, you may use the file compression program WINZIP. Preferred file formats are dbase (or Microsoft Visual FoxPro), and Microsoft Access. Excel files are not accepted. Please send the data via overnight delivery along with a letter signed by the hospital representative certifying the accuracy of the data to the following address: Open Heart Surgery Project Office Health Care Quality Assessment New Jersey Department of Health & Senior Services 240 West State Street, th floor Trenton, New Jersey

5 Quarterly Activity Following each quarterly submission, the Department will run an error trapping program to identify data entry errors. This program generates hospital specific reports listing the number of procedures by type, by surgeon, and any identified data entry errors including missing information. The program will also check possible duplicate records. Each hospital will be sent its error report for verification and/or corrections. Hospitals will have thirty (30) days to respond to this error report by submitting a corrected year-to-date cumulative file along with a dated and signed letter of certification from the hospital representative responsible for the project. If the Department does not receive the information as requested within the 30-day deadline, the Department will assume there are no corrections to be made. Failure to submit corrected data may result in hospitals not meeting licensure requirements. In addition to the quarterly data submission, hospitals may submit mortality cases to be considered for exclusion from the annual Cardiac Surgery Report Card. The criteria for exclusion consideration are as follows: the patient has just been or is being resuscitated en route to the operation room, an angioplasty or cardiac catheterization crash, or the death was caused by complications of a second operation unrelated to the cardiac surgery. To submit cases for possible exclusion, complete the form entitled Application for Case Exclusion (Appendix I). The completed form should be accompanied with a completely blinded copy (i.e., hospital, physician and patient identifiers removed) of the medical record documentation of each case submitted for exclusion. The medical record documentation should include the operative report, discharge summary and any other medical record that substantiates the case for exclusion. This blinded medical record package will be the one reviewed by the Department s Clinical Review Panel. For administrative purposes, the submission should also include a full set of non-blinded documentation for each case. Annual Activity Hospital specific frequency analysis tables will be generated and distributed. Hospitals will be given thirty (30) days to respond to this mailing. If a hospital s revised data is not received as requested, the Department will assume there are no corrections to be made in the hospital s data. In addition, the Department will perform an internal review of the data by matching records from the Open Heart Surgery data against the Uniform Billing records (UB-92) and the State Death Registry to verify mortality status. If any discrepancies are identified, the Department will contact the hospital(s) for corrections and/or clarifications. The only corrections accepted after the database closure will be those requested by the Department. Any exceptions to this policy must be submitted in writing to the Director, Office of Health Care Quality Assessment. Accompanying this request should be any medical record documentation (if applicable) which may be reviewed by the Department s Clinical Panel. It is at the Department s discretion to accept or reject any request for a change on records after the database is closed. 3

6 Audit and Department Review Upon receipt of the final updated data from hospitals, the Department will consider the annual data closed for any changes or updates. The Department will then review the latest data submissions to ensure that all requested corrections were made. Any requests that were not corrected by the hospital may be selected as part of the medical record audit. The closed data will constitute the sampling frame from which a sample will be drawn for the medical record audit. The selected sample data file will be given to an auditor, contracted by the Department, to review the sampled medical records for consistency and accuracy of reporting. The auditor will provide the hospital a copy of the audit report that it submits to the Department. Hospitals will have 30 working days following their audits to make any corrections generated by the audit or request a review of the audit findings through buck slips within 0 days following the audit. Any buck slip submitted by the hospital should be accompanied with all supporting documents on the patient s medical records along with a summary statement describing why the hospital believes the audit findings are incorrect. The Department will review the buck slips and determine the merits of the buck slips on a case-by-case basis based on the additional information provided. The Department will notify the hospital on its decision regarding the contested cases and request a revised data submission reflecting the changes. After the data are updated, the Department will produce a final frequency table to be reviewed by each hospital. Upon receipt of the final frequency tables, hospitals will have thirty (30) days to review and submit letter of certification to the Department. The Cardiac Surgery Report The certified data will be used to produce the Cardiac Surgery Report. This report will assess their risk-adjusted mortality rates by hospital, surgeon and for the state. The risk-adjusted mortality rate estimate is the result of a rigorous statistical model which takes into account preoperative riskfactors of patients as well as their socio-demographic characteristics. 4

7 CARDIAC SURGERY PROJECT Quarterly Activity Year-to-date cumulative data submission due to the Department 30 days after close of quarter. Department runs error trapping program and distributes to hospitals. Hospitals respond within 30 days to error trapping report. Annual Activity Run error trapping program, produce frequency tables reported deaths verified through data matching. Hospitals have 30 days to respond to error reports and other inconsistencies identified. Database closed for Auditing. Sample selected and audit conducted. Hospital has 30 days to submit corrected data based on audit findings. Final frequency analysis performed. Hospitals sign off on data. Database is closed for analysis. Cardiac Surgery Report produced. 5

8 New Jersey Department of Health and Senior Services OPEN HEART SURGERY RISK STRATIFICATION PROJECT DATA COLLECTION FORM, VERSION 4. A. DEMOGRAPHICS Patient: Last Name (): First Name (2): MI(3): Date of Birth (mm/dd/yyyy)(4): / / Gender (5): Male = 0 Female = SS# (6): - - Medical Record # (7): Patient Zip Code (8): Race (9): White= Black=2 Asian=3 Native American/Alaska Native=4 Hawaiian/Other Pacific Islander=5 Other=6 Multiracial=7 Hispanic or Latino (0): No=0 Yes= Referring Cardiologist: Last Name (): First Name (2): MI(3): Referring Physician: Last Name (5): First Name (6): MI(7): B. HOSPITALIZATION Hospital Code (8): Medical Facility Transferred From Code (9): Payor (20): Blue Cross/Blue Shield= Commercial=2 HMO=3 Medicaid=4 Medicare=5 Self-Pay=6 Tricare (CHAMPUS)=7 Uninsured/Indigent=8 Other=9 Date of Admission (mm/dd/yyyy)(2): / / Date of Surgery (mm/dd/yyyy)(22): / / Date of Discharge (mm/dd/yyyy)(23): / / Discharged Where (24): Not Discharged=0 Home= Other Acute Care Hosp=2 Rehab/Sub-Acute=3 Nursing Home=4 Other=5 Deceased=6 Unknown=9 C. PREOPERATIVE RISK FACTORS Weight (25): (kg) Height (26): (cm) Ever Smoker (27): No=0 Yes= If Yes, Current Smoker (28): No=0 Yes= Diabetes (29): No=0 Yes= If Yes, Control Type (30): None=0 Diet= Oral=2 Insulin=3 Other=4 Dyslipidemia (3): No=0 Yes= If Yes, Control Type (32): None=0 Statin= Non-Statin=2 Both=3 Last Creatinine Level Preop (33): Renal Failure (34): No=0 Yes= If Yes, Dialysis (35): No=0 Yes= Hypertension (36): No=0 Yes= Cerebrovascular Accident (37): No=0 Yes= If Yes, When (38): Recent <2 Weeks= Remote >2 Weeks=2 Cerebrovascular Disease (CVD) (39): No=0 Yes= If Yes, Type of CVD (40): Coma= CVA=2 RIND=3 TIA=4 Non-Invasive >79%=5 Prior Carotid Surgery=6 Infectious Endocarditis (4): No=0 Yes= If Yes, Type (42): Treated= Active=2 Chronic Lung Disease (43): No=0 Mild= Moderate=2 Severe=3 Immunosuppressive Therapy (44): No=0 Yes= Peripheral Vascular Disease (45): No=0 Yes= D. PREVIOUS CV INTERVENTIONS Incidence (46): First CV Surgery= First reop=2 Second reop=3 Third reop=4 Four or more reops=5 Prior PCI (47): No=0 Yes= If Yes, Prior PCI-Interval (48): <6 Hours= >6 Hours=2 E. PREOPERATIVE CARDIAC STATUS Myocardial Infarction (49): No=0 Yes= If Yes, When (50): <6 Hours= >6 Hours but<24 Hours=2-7 Days=3 8-2 Days=4 >2 Days=5 Congestive Heart Failure (5): No=0 Yes= Angina (52): No=0 Yes= If Yes, Angina Type (53): Stable= Unstable=2 Cardiogenic Shock (54): No=0 Yes= If Yes, Cardiogenic Shock Type (55): Refractory Shock= Hemodynamic Instability=2 Resuscitation (56): No=0 Yes= Arrhythmia (57): No=0 Yes= If Yes, Arrhythmia Type (58): None=0 Sust VT/VF= Heart Block=2 AFib/Flutter=3 NYHA Classification (59): I = II = 2 III = 3 IV = 4 HCQ-9 (formerly HCQO-22) APR 2 Page of 3 Pages

9 F. PREOPERATIVE MEDICATIONS New Jersey Department of Health and Senior Services OPEN HEART SURGERY RISK STRATIFICATION PROJECT DATA COLLECTION FORM, VERSION 4. (Continued) Beta Blockers (60): No=0 Yes= ACE Inhibitors/ARBs (6): No=0 Yes= Contraindicated=2 Nitrates-IV (62): No=0 Yes= Anticoagulants (63): No=0 Yes= If Yes, Anticoagulant Medication Name (64): Heparin (Unfractionated)= Heparin (Low molecular)=2 Thrombin Inhibitors=3 Other=4 Coumadin (65): No=0 Yes= Inotropes (66): No=0 Yes= Steroids (67): No=0 Yes= Aspirin (68): No=0 Yes= ADP Inhibitor (69): No=0 Yes= Glyco IIB IIIA (70): No=0 Yes= Other (7): No=0 Yes= G. PREOPERATIVE HEMODYNAMICS AND CATH Number of Diseased Coronary Vessels (Left Main Counts as Two) (72): None=0 One= Two=2 Three=3 Left Main Disease (> 50% Occlusion) (73): No=0 Yes= Ejection Fraction Done (74): No=0 Yes= If Yes, Ejection Fraction % (75): Ejection Fraction Method (76): LVgram= Radionuclide=2 Estimate=3 Echo=4 MRI=5 Other=6 H. OPERATIVE PROCEDURE Surgery: Last Name (77): First Name (78): MI(79): License #(80): Status of Procedure (8): Elective= Urgent=2 Emergent=3 Emergent Salvage=4 If Urgent, Reason (82): AMI= IABP=2 Worsening CP=3 CHF=4 Anatomy=5 USA=6 Rest Angina=7 Valve Dysfunction=8 Aortic Dissection=9 Angiographic Accident=0 Cardiac Trauma= Infected Device=2 Syncope=3 PCI/CABG Hybrid=4 PCI Failure w/o Clinical Deterioration=5 If Emergent,, Reason (83): Shock Circ Supp= Shock No Circ Supp=2 Pulmonary Edema=3 AEMI=4 Ongoing Ischemia=5 Valve Dysfunction=6 Aortic Dissection=7 Angiographic Accident=8 Cardiac Trauma=9 Infected Device=0 Syncope= PCI/CABG Hybrid=2 Anatomy=3 Operative Category (84): CAB= CAB+Valve=2 CAB+Other=3 CAB+Valve+Other=4 Valve=5 Valve+Other=6 Other=7 Robotic Technology used (85): No=0 Yes= Minimally Invasive Incision Attempted (86): No=0 Yes= If Yes, Conversion to Standard Incision (87): No=0 Yes= CPB Utilization (88): None=0 Combination= Full=2 If Combination or Full, Perfusion Time (min) (89): Aortic Occlusion (90): None=0 Aortic Crossclamp= Balloon Occlusion=2 Partial Crossclamp=3 If Aortic Crossclamp or Balloon Occlusion, Cross Clamp Time (min) (9): Cardioplegia (92): No=0 Yes= IABP (93): No=0 Yes= If Yes, When Inserted (94): Preoperatively= Intraoperatively=2 Postoperatively=3 Indication (95): Hemodynamic Instability= PTCA Support=2 Unstable Angina=3 CPB Wean=4 Prophylactic=5 Blood Products Used During Surgery (96): No=0 Yes= I. CORONARY BYPASS Number of Distal Anastomoses With Arterial Conduits (97): Number of Distal Anastomoses With Venous Conduits (98): Number of IMA Distal Anastomoses (99): Number of Radial Artery Distal Anastomoses (00): Number of Gastro-Epiploic Artery (GEPA) Distal Anastomoses (0): Other Arterial Anastomoses (02): HCQ-9 (formerly HCQO-22) APR 2 Page 2 of 3 Pages

10 New Jersey Department of Health and Senior Services OPEN HEART SURGERY RISK STRATIFICATION PROJECT DATA COLLECTION FORM, VERSION 4. (Continued) J. VALVE SURGERY Aortic (03): No=0 Replacement= Repair/Reconstruct=2 Root Reconstruction with Valve Conduit=3 Replacement + Aortic Graft Conduit (not a valve conduit)=4 Root Reconstruction with Valve Sparing=5 Resuspension Aortic Valve with Replacement of Ascending Aorta=6 Resuspension Aortic Valve w/o Replacement of Ascending Aorta=7 Resection Sub-Aortic Stenosis=8 Apico-Aortic Conduit=9 Autograft with Pulmonary Valve-Ross Procedure=0 Homograft= Mitral (04): No=0 Annuloplasty Only= Replacement=2 Reconstruction with Annuloplasty=3 Reconstruction without Annuloplasty=4 Tricuspid (05): No=0 Annuloplasty Only= Replacement=2 Reconstruction with Annuloplasty=3 Reconstruction without Annuloplasty=4 Valvectomy=5 Pulmonic (06): No=0 Replacement= Repair/Reconstruction=2 Valvectomy=3 K. OTHER PROCEDURES Left Vent Aneurysm Repair (07): No=0 Yes= Vent. Septal Defect Repair (08): No=0 Yes= Atrial Septal Defect Repair (09): No=0 Yes= Surgical Ventricular Restoration (0): No=0 Yes= Congenital Defect Repair (): No=0 Yes= TMR (2): No=0 Yes= Cardiac Trauma Repair (3): No=0 Yes= Cardiac Transplant (4): No=0 Yes= Pacemaker (5): No=0 Yes= AICD (6): No=0 Yes= Atrial Fib Correction (7): None=0 MAZE= Other=2 Combination=3 Aortic Aneurysm Repair (8): No=0 Yes= Other Cardiac (9): No=0 Yes= Carotid Endarterectomy (20): No=0 Yes= Other Vascular (2): No=0 Yes= Other Thoracic (22): No=0 Yes= VAD (23): None=0 LVAD= RVAD=2 BiVAD=3 Other non-cardiac (24) No=0 Yes= L. IN HOSPITAL COMPLICATIONS OPERATIVE: INFECTION: Reop-Bleeding/Tamponade (25): No=0 Yes= Sternal-Deep (3): No=0 Yes= Reop-Valvular Dysfunction (26): No=0 Yes= Thoracotomy (32): No=0 Yes= Reop-Graft Occlusion(27): No=0 Yes= Leg (33): No=0 Yes= Reop-Other Cardiac Problem (28): No=0 Yes= Septicemia (34): No=0 Yes= Reop-Other Non-Cardiac Problem (29): No=0 Yes= UTI (35): No=0 Yes= Perioperative MI (30): No=0 Yes= NEUROLOGIC: PULMONARY: Postoperative Stroke For >24 Hrs (36): No=0 Yes= Prolonged Ventilation (39): No=0 Yes= Transient Neurologic Deficit (37): No=0 Yes= Pulmonary Embolism (40): No=0 Yes= Continuous Coma >24 Hours (38): No=0 Yes= Pneumonia (4): No=0 Yes= RENAL: Renal Failure (42): No=0 Yes= If Yes, Dialysis (43): No=0 Yes= VASCULAR: Iliac/Femoral Dissection (44): No=0 Yes= Acute Limb Ischemia (45): No=0 Yes= OTHER: Heart Block (46): No=0 Yes= Cardiac Arrest (47): No=0 Yes= Anticoagulant (48): No=0 Yes= Tamponade (49): No=0 Yes= GI Complication (50): No=0 Yes= Multi System Failure (5): No=0 Yes= A-Fib/Flutter (52): No=0 Yes= Aortic Dissection (53): No=0 Yes= Other (54): No=0 Yes= If Yes, Specify (55): M. MORTALITY Discharge Status (56): Alive= Dead=2 Status at 30 Days after Surgery (60): Alive= Dead=2 Unknown=3 If Dead, Date of Death (mm/dd/yyyy) (57): / / Location of Death (58): OR During Initial Surgery= Hospital=2 Home=3 Other Care Facility=4 OR During Reoperation=5 Unknown=6 Extended Care Facility=7 Hospice=8 Acute Rehab=9 Other=0 Primary Cause of Death (Select Only One) (59): Cardiac= Neurologic=2 Renal=3 Vascular=4 Infection=5 Pulmonary=6 Valvular=7 Other=8 Unknown=9 HCQ-9 (formerly HCQO-22) APR 2 Page 3 of 3 Pages

11 DATA DEFINITIONS AND SPECIFICATIONS A. DEMOGRAPHICS. Patient s Last Name [LNAME] Indicate the patient s last name. 2. Patient s First Name [FNAME] Indicate the patient s first name. 3. Patient s Middle Initial [MI] Indicate the patient s middle initial if available. 4. Date of Birth [DOB] Indicate the month, day, and year of the patient s date of birth. 5. Gender [SEX] / / MM/DD/YYYY Indicate the patient s gender or sex. 0 = Male = Female 6. Social Security Number [SSNUM] Indicate the patient s social security number in the USA. (nine digits SSN) 7. Medical Record Number [MEDRECNO] Indicate the patient s medical record number at the hospital where surgery occurred. (Medical Record #) 8. Patient Zip Code [ZIP] Indicate the patient s five digit zip code of the patient s residence. (5 digit zip code) 9

12 9. Race [RACE] Enter the patient s race as determined by the patient. If multiple races are provided by the patient, enter the race the patient identifies with the most. =White 2=Black 3=Asian (e.g., Indian, Pakistani, Chinese, Korean, etc.) 4=Native American/Alaska Native 5=Hawaiian/Other Pacific Islander 6=Other 7=Multiracial 0. Hispanic or Latino Origin of the Patient [Hispanic] This field refers to whether or not a patient identifies himself/herself as Hispanic or Latino. A person who answered white, black, Asian, etc. in the race category may answer yes for Hispanic or Latino origin. (Not Hispanic or Latino) (Hispanic or Latino). Referring Cardiologist s Last Name [CARDLNAME] Indicate the referring cardiologist s last name. 2. Referring Cardiologist s First Name [CARDFNAME] Indicate the referring cardiologist s first name. 3. Referring Cardiologist s Middle Initial [CARDMI] Indicate the referring cardiologist s middle initial if available. If unknown, leave blank. 4. NO FIELD 5. Referring Physician s Last Name [REFLNAME] Indicate the physician s last name. 6. Referring Physician s First Name [REFFNAME] Indicate the physician s first name. 7. Referring Physician s Middle Initial [REFMI] Indicate the physician s middle initial if available. If unknown, leave blank. 0

13 B. HOSPITALIZATION 8. Present Hospital [PRESHOSP] Indicate the hospital code in which the current surgical procedure was performed using the list below. The assigned codes are consistent with Medicare provider numbers and are the same used in UB-92 discharge form. CODE HOSPITAL 064 AtlantiCare Regional Medical Center 040 Cooper University Medical Center 030 Deborah Heart and Lung Center 0450 Englewood Hospital and Medical Center 000 Hackensack University Medical Center 0740 Jersey City Medical Center 0730 Jersey Shore University Medical Center 050 Morristown Memorial Hospital 0020 Newark Beth Israel Medical Center 0290 Our Lady of Lourdes Medical Center 0380 Robert Wood Johnson University Hospital 0760 Saint Barnabas Medical Center 020 St. Francis Medical Center 090 St. Joseph s Regional Medical Center 0060 St. Mary s Hospital 0960 St. Michael s Medical Center 90 UMDNJ/University Hospital 020 Valley Hospital 9. Hospital Transferred From [TXFROM] Enter the hospital code the patient transferred from the list provided below. Do not include outpatient clinics or labs. Use the following hospital codes which are based on Medicare provider numbers, utilizing the hospital division code. Please note that the last digit refers to the hospital division code. Notes: Use 0000 for no transfers. Use 8888 for VA hospitals. Use 9999 for out of state hospitals.

14 # 9: Hospital Code Hospital Name 0000 No Transfer 0642 AtlantiCare Regional Medical Center-City 064 AtlantiCare Regional Medical Center-Mainland 0250 Bayonne Medical Center 20 Bayshore Community Hospital 0580 Bergen Regional Medical Center 00 Cape Regional Medical Center 0920 Capital Health System at Fuld 0440 Capital Health System at Hopewell 0 CentraState Medical Center 070 Chilton Memorial Hospital 060 Christ Hospital 0090 Clara Maass Medical Center 040 Community Medical Center 040 Cooper Hospital/University Medical Center 030 Deborah Heart and Lung Center 0830 East Orange General Hospital 0450 Englewood Hospital and Medical Center 000 Hackensack University Medical Center 50 Hackettstown Community Hospital 0400 Hoboken University Medical Center 0080 Holy Name Hospital 0050 Hunterdon Medical Center 0740 Jersey City Medical Center 0730 Jersey Shore University Medical Center 080 JFK Medical Center (Edison) 0862 Kennedy Mem. Hospitals UMC-Cherry Hill 0863 Kennedy Mem. Hospitals UMC-Stratford 086 Kennedy Mem. Hospitals UMC-Wash. Twp Kimball Medical Center 060 Lourdes Medical Center of Burlington Cty. 80 Meadowlands Hospital Medical Center 090 Memorial Hospital of Salem County 0750 Monmouth Medical Center 050 Morristown Memorial Hospital 0540 Mountainside Hospital 0020 Newark Beth Israel Medical Center 0280 Newton Medical Center 0522 Ocean Medical Center 2

15 # 9: Hospital Code Hospital Name 0290 Our Lady of Lourdes Medical Center 050 Overlook Hospital 0030 Palisades General Hospital of New York 0392 Raritan Bay Medical Center-Old Bridge 039 Raritan Bay Medical Center-Perth Amboy 0340 Riverview Medical Center 0380 Robert Wood Johnson University Hospital 00 RWJ University Hospital at Hamilton 0240 RWJ University Hospital at Rahway 0470 Shore Memorial Hospital 0480 Somerset Medical Center 0322 South Jersey Regional Medical Center 0690 South Jersey Hospital-Elmer 30 Southern Ocean Medical Center 0760 St. Barnabas Medical Center 0500 St. Clare's Hospital-Denville 0502 St. Clare s Hospital-Dover 200 St. Clare's Hospital-Sussex 020 St. Francis Medical Center 090 St. Joseph's Regional Medical Center 09 St. Joseph's Wayne Hospital 0060 St. Mary's Hospital (Passaic) 0960 St. Michael s Medical Center 0700 St. Peter's University Hospital 0270 Trinitas Hospital 90 UMDNJ-University Hospital 080 Underwood - Memorial Hospital 000 University Medical Center at Princeton 020 Valley Hospital 0570 Virtua-Memorial Hospital Burlington Cty Virtua-West Jersey Hospital Berlin 0224 Virtua-West Jersey Hospital Marlton 022 Virtua-West Jersey Hospital Voorhees 0600 Warren Hospital 0880 William B. Kessler Memorial Hospital 8888 VA Hospital 3

16 20. Primary Payor [INSURER] Indicate the primary insurer of the patient (See Appendix II for additional explanation of insurer classification). = Blue Cross 2= Commercial 3= HMO 4= Medicaid 5= Medicare 6= Self Pay 7= Tricare (CHAMPUS) 8= Uninsured/Indigent 9= Other 2. Date of Admission [DATEADMIN] Indicate the date the patient was admitted for this surgical procedure. / / MM/DD/YYYY 22. Date of Surgery [DATEOPERA] Indicate the date of surgery which equals the date the patient enters the OR. / / MM/DD/YYYY 23. Date of Discharge [DATEDC] Indicate the date the patient was discharged from the hospital (acute care). If the patient died in the hospital, the discharge date is the date of death. / / MM/DD/YYYY 24. Discharged Where [DCWHERE] Indicate where the patient was sent to or discharged to after surgery. If the patient is not discharged, enter 0. t Discharged =Home 2=Other Acute Care Hospital 3=Rehab/Sub-Acute 4=Nursing Home 5=Other 6=Deceased 9=Unknown 4

17 C. PREOPERATIVE RISK FACTORS 25. Weight [WT] Indicate the patient s weight in kilograms (round up to the next whole number) ( lb =.45 kg or alternatively, kg = 2.2 lbs). 26. Height [HT] Kilograms (Valid range is ) Indicate the height of the patient in centimeters ( inch = 2.54 centimeters). Centimeters (Valid range is ) 27. Smoker - Ever [SMOKEREVR] Indicate whether the patient has a history confirming any form of tobacco use in the past (cigarettes, cigar, chewing tobacco, snuff, etc.). Note: this definition is different from the STS definition. 28. Smoker - Current [SMOKECURR] Indicate whether the patient is a current smoker (or tobacco products user). Patients with a use of tobacco (cigarettes, cigar, chewing tobacco, snuff, etc.) within one month of surgery are considered to be current smokers (or current tobacco users). Note: this definition is different from the STS definition. 29. Diabetes [DIABETES] Indicate whether the patient has a history of diabetes, regardless of duration of disease or need for anti-diabetic agents. Includes on admission or preoperative diagnosis. Does not include gestational diabetes. 30. Diabetic Control [DIABCONT] Indicate the method of diabetic control. Code the control method patient presented with on admission. Patients placed on a pre-operative diabetic pathway of insulin drip but at admission were controlled with none, diet or oral method are not coded as insulin dependent. Byetta should be coded as Other. ne =Diet 2=Oral 3=Insulin 4=Other 5

18 3. Dyslipidemia [DYSLIPIDEMIA] Indicate if the patient has prior history of dyslipidemia diagnosed and/or treated by a physician. Criteria can include documentation of:. Total cholesterol greater than 200 mg/dl, or 2. LDL greater than or equal to 30 mg/dl, or 3. HDL less than 30 mg/dl, or 4. Admission cholesterol greater than 200 mg/dl, or 5. Triglycerides greater than 50 mg/dl Note: If treatment was initiated because the LDL was >00 mg/dl (2.59 mmole/l) in patients with known coronary artery disease, this would quantify as a "Yes". Any pharmacological treatment qualifies as a "Yes". 32. Dyslipidemia Control [DYSLIPCONT] Indicate the lipid lowering medication the patient was on within 24 hours preceding surgery. ne =Statin 2=Non-Statin 3=Both 33. Pre-Op Creatinine Level [CREATININE] Indicate the most recent creatinine level prior to surgery. A creatinine level should be collected on all patients for consistency, even if they have no prior history. A creatinine level is a high predictor of a patient's outcome. (Valid range is ) 34. Renal Failure [RENAL] Indicate whether the patient has ) a documented history of renal failure and/or 2) a history of creatinine > 2.0. Prior renal transplant patients are not included as pre-op renal failure unless since transplantation their creatinine has been or currently is > Dialysis [DIALYSIS] Indicate whether the patient is currently undergoing dialysis. 36. Hypertension [HYPERTEN] Indicate whether the patient has a diagnosis of hypertension, documented by one of the following: 6

19 a. Documented history of hypertension diagnosed and treated with medication, diet and/or exercise. b. Blood pressure > 40 systolic or > 90 diastolic on at least 2 occasions. c. Is currently on antihypertensive medication. 37. Cerebrovascular Accident [CVA] Indicate whether the patient has a central neurologic deficit persisting more than 72 hours (i.e. extremity weakness or loss of motion, loss of consciousness, loss of speech, field cuts). 38. CVA-When [CVAWHEN] Indicate when the CVA events occurred. Those events occurring within two weeks of the surgical procedure are considered recent, while all others are considered remote. =Recent (<=2 weeks) 2=Remote (>2 weeks) 39. Cerebrovascular Disease [CVD] Indicate whether the patient has Cerebro-Vascular Disease, documented by any one of the following: Unresponsive coma > 24 hrs CVA (symptoms > 72 hrs after onset) RIND (recovery within 72 hrs); TIA (recovery within 24 hrs) Non-invasive carotid test with > 79% occlusion, Prior carotid surgery or Does not include neurological disease processes such as metabolic and/or anoxic ischemic encephalopathy. 40. Cerebrovascular Disease Type [CVDTYPE] Indicate whether the patient has a history of cerebrovascular disease, documented by any one of the following: Unresponsive coma greater than 24 hours: Patient experienced complete mental unresponsiveness and no evidence of psychological or physiologically appropriate responses to stimulation. Cerebrovascular Accident (CVA): Patient has a history of stroke, i.e., loss of neurological function with residual symptoms at least 72 hours after onset. Reversible Ischemic Neurologic Deficit (RIND) - Patient has a history of loss of neurological function with symptoms at least 24 hours after onset 7

20 but with complete return of function within 72 hours. Transient Ischemic Attack (TIA) - Patient has a history of loss of neurological function that was abrupt in onset but with complete return of function within 24 hours. Non-invasive/invasive carotid test with > 79% occlusion. Prior carotid surgery. If more than one, select the most recent to the operative procedure. Select one of the following: = Coma 2 = CVA 3 = RIND 4 = TIA 5 = Non-Invasive > 79% 6 = Prior carotid surgery 4. Infective Endocarditis [ENDOCARD] Indicate whether the patient has a history of infectious endocarditis documented by one of the following:. Positive blood cultures 2. Vegetation on echocardiography 3. Documented history of infectious endocarditis 42. Infective Endocarditis Type [ENDOTYPE] Indicate the type of endocarditis the patient has. If the patient is currently being treated for endocarditis, the disease is considered active. If no antibiotic medication (other than prophylactic medication) is being given at the time of surgery, then the infection is considered treated. =Treated 2=Active 43. Chronic Lung Disease [LUNGDIS] Indicate whether the patient has chronic lung disease, and the severity level according to the following classification: =Mild: FEVI 60% to 75% of predicted, and/or on chronic inhaled or oral bronchodilator therapy. 2=Moderate: FEVI 50% to 59% of predicted, and/or on chronic steroid therapy aimed at lung disease. 3=Severe: FEVI < 50% predicted, and/or Room Air po2 < 60 or Room Air pco2>50 8

21 44. Immunosuppressive Therapy [IMMUNOSUP] Indicate whether the patient has used any form of immunosuppressive therapy (i.e. systemic steroid therapy) within 30 days preceding the operative procedure. This does not include topical applications and inhalers or one time systemic therapy. 45. Peripheral Vascular Disease [PVD] Indicate whether the patient has Peripheral Vascular Diseases, as indicated by claudication either with exertion or rest; amputation for arterial insufficiency; aortoiliac occlusive diseases reconstruction; peripheral vascular bypass surgery, angioplasty, or stent; documented AAA, AAA repair, or stent; positive non-invasive testing documented. Does not include procedures such as vein stripping, carotid disease. D. PREVIOUS CV INTERVENTIONS 46. Incidence [INCIDENCE] Indicate if this is the patient's first cardiovascular surgery, first re-op cardiovascular surgery, second re-op cardiovascular surgery, third re-op cardiovascular surgery, fourth or more re-op cardiovascular surgery. 47. Prior PCI [PRIORPCI] =First CV surgery 2=First re-operation 3=Second re-operation 4=Third re-operation 5=Four or more re-operations Indicate whether a previous Percutaneous Coronary Intervention (PCI) was performed any time prior to this surgical procedure by answering "Yes" or "No". PCI refers to those treatment procedures that unblock narrowed coronary arteries without performing surgery. PCI may include, but is not limited to: ) Balloon Catheter Angioplasty, Percutaneous Transluminal Coronary Angioplasty (PTCA) 2) Rotational Atherectomy 3) Directional Atherectomy 4) Extraction Atherectomy 5) Laser Atherectomy 6) Intracoronary Stent Placement 7) Previous Pacemaker 8) Previous AICD Note: this definition is different from the STS definition. 9

22 48. Prior PCI Interval [PCIINTERV] Indicate the interval of time between the previous PCI and the current surgical procedure. Leave blank if no previous PCI. =<=6Hours 2=>6Hours E. PREOPERATIVE CARDIAC STATUS 49. Myocardial Infarction [MIYN] Indicate whether the patient has a history of an MI. For MI occurrence prior to current hospitalization, one of the following is necessary:. MI documented in the medical record, OR 2. EKG documented Q wave. Q wave to be.03 seconds in width and/or greater than or equal to one third of the total QRS complex in two or more contiguous leads. For MI occurrence during current hospitalization, two of the following criteria are necessary:. Ischemic symptoms in the presence or absence of chest discomfort. Ischemic discomfort may include: a. Chest, epigastric, arm, wrist or jaw discomfort with exertion or at rest; b. Unexplained nausea and vomiting; c. Persistent shortness of breath secondary to left ventricular failure; d. Unexplained weakness, dizziness, lightheadedness, diaphoresis or syncope. 2. Enzyme level elevation. One of the following four are necessary: a. CK-MB: - Maximal value of CK-MB > 2 x the upper limit of normal on one occasion during the first hours after the index clinical event OR - Maximal value of CK-MB, preferable CK-MB mass > upper limit of normal on two successive samples; b. CK>2x the upper limit of normal; c. LDH subtype > LDH subtype 2; d. Maximal concentration of troponin T or I > the MI decision limit on at least one occasion during the first 24 hours after the index clinical event. 3. Serial ECG (at least two) showing changes from baseline or serially in ST-T. 20

23 50. MI When [MIWHEN] Indicate the time period between the last documented MI and surgery. = <= 6 hours 2= > 6 hours but <24 hours 3= to 7 days 4= 8 to 2 days 5= > 2 days 5. Congestive Heart Failure [CHF] Indicate whether, within 2 weeks prior to the initial surgical procedure, a physician has diagnosed that patient is currently in congestive heart failure (CHF). CHF can be diagnosed based on careful history and physical exam, or by one of the following criteria:. Paroxysmal nocturnal dyspnea (PND) 2. Dyspnea on exertion (DOE) due to heart failure 3. Chest X-Ray (CXR) showing pulmonary congestion 4. Pedal edema or dyspea and receiving diuretics or digoxin 52. Angina [ANGINAYN] Indicate whether the patient has ever had angina pectoris. 53. Angina Type [ANGINATYPE] Indicate the type of angina present prior to this surgical intervention. = Stable: Angina that is controlled by oral and/or transcutaneous medication. Patients that are pain free with or without medication but with a history of angina are captured here. 2 = Unstable: Angina which necessitates the initiation, continuation or increase of angina control therapies that may include: nitroglycerin drip, heparin drip or IABP placement. The type of angina may include, but is not limited to: rest angina, new onset exertional angina of at least New York Heart Association (NYHA) Class III in severity, recent acceleration in pattern and increase of one NYHA class to at least NYHA Class III, variant angina, non-q wave myocardial infarction, or post-infarction angina. 2

24 54. Cardiogenic Shock [CARDIOGEN] Indicate whether the patient was, at the time of procedure, in a clinical state of hypoperfusion according to either of the following criteria: Systolic BP < 80 and/or Cardiac Index <.8 despite maximal treatment; IV inotropes and/or IABP necessary to maintain Systolic BP > 80 and/or CI > Cardiogenic Shock Type [SHOCKTYPE] Indicate which of the following types of cardiogenic shock is present. Select one: =Refractory Shock: Systolic BP < 80 and/or Cardiac Index (CI) <.8 despite maximal treatment 2=Hemodynamic Instability: IV inotropes and/or IABP necessary to maintain Systolic BP > 80 and CI > Resuscitation [RESUSCIT] Indicate whether the patient required cardiopulmonary resuscitation within one hour before the start of the operative procedure. 57. Arrhythmia [ARRHYTH] Indicate whether there is a history of preoperative arrhythmia (sustained ventricular tachycardia, ventricular fibrillation, atrial fibrillation, atrial flutter, third degree heart block) that has been clinically documented or treated with any of the following treatment modalities: ablation therapy AICD pacemaker pharmachological treatment electrocardioversion 58. Arrhythmia Type [ARRHYTHTYPE] Indicate which arrhythmia is present within two weeks of the procedure; choose one: Sustained Ventricular Tachycardia (VT) or Ventricular Fibrillation (VF) requiring cardioversion and/or IV amiodarone, third degree heart block, atrial fibrillation/flutter requiring treatment. ne =Sustained VT/VF 2=Heart block 3=Afib/Flutter 22

25 59. New York Heart Association Classifications [NYHA] Indicate the New York Heart Association Class. NYHA classification represents the overall functional status of the patient in relationship to both congestive heart failure and angina. Code the highest class leading to episode of hospitalization and/or procedure. Select the level of heart function and/or angina leading up to or at the time of the procedure, whichever is highest. =Class I: Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. 2=Class II: Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain. 3=Class III: Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest, less than ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal pain. 4=Class IV: Patients with cardiac disease resulting in inability to carry on with any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased. F. PREOPERATIVE MEDICATIONS 60. Beta Blockers [BETABLKR] Indicate whether the patient received Beta Blockers within 24 hours preceding surgery. 2=Contraindicated 6. Ace Inhibitors/ARBs [ACEINHIB] Indicate whether the patient received Ace Inhibitors or ARBs within 48 hours preceding surgery. 62. Nitrates-I.V. [NITRATEIV] Indicate whether the patient received I.V. Nitrates preceding surgery. 23

26 63. Anticoagulants [ANTICOAG] Indicate whether the patient received IV and/or subq Anticoagulants within 48 hours preceding surgery. Do not capture Coumadin. 64. Anticoagulant Medication Name [ANTICOAGTYPE] Indicate the name of the IV and/or subq Anticoagulant the patient received within 48 hours preceding surgery. =Heparin (Unfractionated) 2=Heparin (Low Molecular) 3=Thrombin Inhibitors 9=Other 65. Coumadin [COUMADIN] Indicate whether the patient received Coumadin within 24 hours preceding surgery. 66. Inotropes [INOTROPES] Indicate whether the patient received IV Inotropic Agents within 48 hours preceding surgery. 67. Steroids [STEROIDS] Indicate whether the patient was taking steroids within 24 hours preceding surgery.. This does not include a one time dose related to prophylaxis therapy (i.e. IV dye exposure for cath procedure or surgery pre-induction period). Non-systematic medications are not included in this category (i.e. nasal sprays, topical creams). 68. Aspirin [ASPIRIN] Indicate whether the patient received Aspirin or Ecotrin within 5 days preceding surgery. 24

27 69. ADP Inhibitor [ADPINHIB] Indicate whether the patient has received ADP Inhibitors within 5 days preceding surgery. 70. Glycoprotein (IIB IIIA) Inhibitor [GLYCO] Indicate whether the patient received Glycoprotein IIB/IIIA inhibitors within 24 hours preceding surgery. These medications are anti-platelet, thrombin agents. 7. Other [OTHERMEDS] Indicate whether the patient received any other medications (i.e., Digitalis, Antiplatelets, Diuretics or Lipid-lowering medications) within 24 hours preceding surgery. G. PREOPERATIVE HEMODYNAMICS AND CATH 72. Number of Diseased Vessels [NUMDISVES] Indicate the number of major coronary systems (LAD system, Circumflex system, and/or Right system) with 50% narrowing in any angiographic view. NOTE: Left Main disease (>=50%) is counted as TWO vessels (LAD and Circumflex). For example, left main and RCA would count as three total. Select one from the following: ne (no significant coronary obstructive disease) =One 2=Two 3=Three 73. Left Main Disease>=50% [LMDISEASE] Indicate whether the patient has Left Main Coronary Disease. Left Main Coronary Disease is present when there is >=50% compromise of vessel diameter in any angiographic view. 74. Ejection Fraction Done [EJDONEYN] Indicate whether the Ejection Fraction was measured prior to the induction of anesthesia. 25

28 75. Ejection Fraction [EFPCT] Indicate the percentage of the blood emptied from the ventricle at the end of the contraction. Use the most recent determination prior to intervention. Enter a percentage in the range of -99. Valid values: -99. (If a range is given, take the mid-point and round up) 76. Ejection Fraction Method [EJMETHOD] Indicate how the Ejection Fraction measurement information was obtained. =LV Gram (Left Ventriculogram) 2=Radionuclide: 3=Estimate (based upon available clinical data) 4=ECHO 5=MRI 6=Other H. OPERATIVE PROCEDURE 77. Surgeon Last Name [SURGLNAME] Enter the surgeon s last name. 78. Surgeon First Name [SURGFNAME] Enter the surgeon s first name. 79. Surgeon Middle Initial [SURGMI] Enter the surgeon s middle initial. 80. Surgeon License Number [SURLIC] Enter the 0-digit surgeon s license number starting with MA or MB as MA or MB (e.g., MA ). 8. Status (Urgency) of Procedure [PREOPSTAT] Indicate the status that best describes the clinical status of the patient at the time of surgery. =Elective: The patient s cardiac function has been stable in the days or weeks prior to the operation. The procedure could be deferred without increased risk of compromised cardiac outcome. 2=Urgent: ALL of the following conditions are met: - Not elective status. - Not emergent status. - Procedure required during same hospitalization in order to minimize chance of further clinical deterioration. -Worsening, sudden chest pain, CHF, AMI, anatomy, IABP, Unstable Angina (USA) with IV nitroglycerin (NTG) or rest angina may be included. 26

29 3=Emergent: The patient s clinical status includes any of the following: a) Ischemic dysfunction (any of the following): - Ongoing ischemia including rest angina despite maximal medical therapy (medical and/or IABP); - Acute Evolving MI within 24 hours before surgery; or - Pulmonary edema requiring intubation. b) Mechanical dysfunction (either of the following): - Shock with circulatory support. - Shock without circulatory support 4=Emergent Salvage: The patient is undergoing CPR en route to the Operating Room or prior to anesthesia induction. 82. Urgent Reason [URGREASON] Delay in the operation is necessitated only by attempts to improve the patient s condition, availability of a spouse or parent for informed consent, availability of blood products, or the availability of results of essential laboratory procedures or test. Indicate which one of the following applies as the reason why the patient had Urgent Status? (Select one) =Acute myocardial infarction (AMI) 2=IABP 3=Worsening, sudden chest pain 4=Congestive Heart Failure (CHF) 5=Coronary Anatomy 6=Unstable angina (USA) with intravenous nitroglycerin (NTG) 7=Rest angina 8=Valve Dysfunction 9=Aortic Dissection 0=Angiographic Accident =Cardiac Trauma 2=Infected Device 3=Syncope 4=PCI/CABG Hybrid 5=PCI Failure w/o clinical deterioration 83. Emergent Reason [EMEREASON] Patients requiring emergency operations will have ongoing, refractory (difficult, complicated, and/or unmanageable) unrelenting cardiac compromise, with or without hemodynamic instability, and not responsive to any form of therapy except cardiac surgery. An emergency operation is one in which there should be no delay in providing operative intervention. Indicate which of the following applies as the reason why the patient had Emergent Status? (Select one) =Shock Circ Supp (Shock with circulatory support) 2=Shock No Circ Supp (Shock no circulatory support) 3=Pulmonary Edema (Pulmonary edema requiring intubation) 4=AEMI (Acute Evolving MI within 24 hours before surgery) 5=Ongoing Ischemia (Ongoing ischemia, including rest angina despite maximal medical therapy (medical and/or IABP) 6=Valve Dysfunction 7=Aortic Dissection 27

30 8=Angiographic Accident 9=Cardiac Trauma 0=Infected Device =Syncope 2=PCI/CABG Hybrid 3=Anatomy 84. Operative Category [OPERCAT] Indicate the type of cardiac surgery that was performed on the patient. =CAB 2=CAB + Valve 3=CAB + Other 4=CAB + Valve + Other 5=Valve 6=Valve + Other 7=Other 85. Robotic Technology Used [ROBOTIC] Indicate whether the cardiac surgery was assisted by robotic technology. 86. Minimally Invasive Incision Attempted [MININVASE]: Was a minimally invasive incision done or attempted? This includes a variety of approaches, which are in some way less invasive than the traditional median sternotomy with full cardiopulmonary bypass and cardioplegic arrest. It may involve either more limited surgical incision(s), less invasive or no cardiopulmonary bypass, or a beating heart. All procedures started as minimally invasive should be included, even if they were converted to a standard approach. Note: this definition is different from the STS definition. 87. Converted to Standard Incision [STD_OHS]: Indicate whether the minimally invasive incision was converted to a full median sternotomy. 88. CPB Utilization [CPBYN] Indicate the level of Cardiopulmonary Bypass (CPB) or coronary perfusion used during the surgical procedure? ne =Combination 2=Full 28

31 89. Perfusion Time [CPBPERF] Indicate the perfusion time in minutes. Perfusion time is defined as an accumulated total of CPB and/or coronary perfusion assist minutes. minutes. 90. Aortic Occlusion [AORTOCCYN] Indicate the type of aortic occlusion used. Indicate the highest level of occlusion. ne (includes beating heart and fibrillating heart) =Aortic Crossclamp (Highest) 2=Balloon Occlusion 3=Partial Crossclamp (Lowest) 9. Crossclamp Time or Balloon Occlusion Time [CROSSTIME] Indicate the total number of minutes the aorta is completely crossed-clamped during bypass. Minutes should not be recorded if partial crossclamp is the highest level of occlusion. minutes 92. Cardioplegia [CARDIOPLEG] Indicate whether cardioplegia was used. 93. Intra Aortic Balloon Pump [IABP] Indicate whether the patient was placed on Intra-aortic balloon pump (IABP). 94. IABP When Inserted [IABPWHEN] Indicate the time of the earliest IAPB insertion. Choose one of the following: =Preoperatively 2=Intraoperatively 3=Postoperatively 95. IABP Indication [IABPIND] Indicate the PRIMARY reason for inserting the IABP: Choose one of the following: =Hemodynamic instability (Hypotension/shock) 2=PTCA support 3=Unstable angina 4=Cardiopulmonary bypass (CPB) weaning failure 5=Prophylactic 29

32 96. Blood Products Used [BLOODPROD] Indicate whether blood products were transfused anytime intraoperatively (i.e. any blood product use that started inside of the OR) during the initial surgery. I. CORONARY BYPASS 97. Number of Distal Anastomoses With Arterial Conduits [ANASTART] Indicate the total number of distal anastomoses with arterial conduits, whether IMA, GEPA, radial artery, etc. (Valid values are 0-9) 98. Number of Distal Anastomoses with Venous Conduits [ANASTVEIN] Indicate the total number of distal anastomoses with venous conduits, e.g. saphenous veins. (Valid values are 0-9) 99. Number of IMA Distal Anastomoses [IMADIST] Indicate the total number of distal anastomoses done using internal mammary artery (IMA) grafts. (Valid values are 0-6) 00. Number of Radial Artery Distal Anastomoses [RADDISTL] Indicate the total number of distal anastomoses done using radial artery grafts. (Valid values 0-6) 0. Number of GEPA Distal Anastomoses [GEPAANAST] Indicate the total number of distal anastomoses done using gastro-epiploic artery grafts. (Valid values 0-6) 02. Number of Other Arterial Anastomoses [OTHARTANAST] Indicate the total number of other arterial distal anastomoses that were used, other than radial, GEPA or IMA. (Valid values 0-6) 30